The URL can be used to link to this page

Home My WebLink About4224-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. ¥. Certificate Of Occupancy No. ~.~.8 ...... Date ........... &~' · 30 ..... , 19. ~'~ THIS CERTIFIES that the building located at l~t;' R,~fSotrtla .D~- ....... Street Map Nolsrea, rn l~IIl, m Block No ........... Lot No. ~.. O~'le,~;~ 'l~iY, ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... 14a~' ..29-., 19'69 pursuant to which Building Permit No...l~221~ dated ............. &!eri:l...3, 19.69, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ...prlva-'c® - ¢me - i'am~'l.y, civil.].lng ..................................... The certificate is issued to .[1]:e,a. Doi4,,rl~- ......... 0~tqt~ ........................ (owner, lessee or tenant) of the aforesaid building. Suffo]k County Department of Health Approval · · ' I~o'R~ ............................ UND~RWRITFRS CERTIFICATE No... ~oRe .......................................... tlOLISE N UM BE R. :~.~'1 ~' ....... Street.. ~¢~tr~,h · 1/'~' · D~ ............................... FOB~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 422~ Z Permission is hereby gronted to: ............ ]~X~..D. eBarA& ................................... ............ ~.r.m~a....~,.],~, ......................................... .................... ~.%.~n.t, ......... ~,~:.,, .......................... to .......... .a....~...~...~....~.~.~..o..~.L..o...n...~.~....,..x.~.~.~..~.~..~..v.~.]..~,....~. ............................................ ............................................... ;x~.?.3, ...5~li.~;~.~ -.Zi~-~-~ .......................................................... at premises located at ................... W~.~.......~.Q~,~;~...~.:~.~.~ ............ ]~tOl~lt~...~t]~. ......................... .................................................... .Or.te~t. ......... ]I..Y. .......................................................................... pursuon,t to opplicotion doted ............................. ~%~:~:L~. ....... ~ ......... , ]9...~.~i, ond opproYed by the Building Inspector, Building Inspector Disapproved' a/c~ ............... (ff i ..................... ate .... .... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings o n premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of lay out of property must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole o~ in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS I-l~e~ay MADE to. the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction cd build ings, additions or alterations, or for removal or demo- lition, as herein described. The applicant agrees to corn ply with all applicable laws, ordinances, building code, housing code, arid regulations. '" iSi~ature of ,applicant, o~ name if a COrlSoration} ........ .~.. .~.~ ................... ,...:t ..... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contrachyr, electrician, plumber or ~ builder... ~.~. tgf-.~7. .................... _- .............. ~c'~' ~'~/~ '~,'~'~p~,~'&' ~ ~" ~ Name of ,owner of premis~ .... ~.~. a ........... (.' ............................ ~" ' If applicant is a corporate, signature of duly authorize d officer. (Name and title of corporate officer) 1. Location of land on which_~ro~o~ed work will be done. Map No...; ............. Lot BI0 .............. Street and Number .STf~f~ ~..'~/.-~./.~/.~/~. 'r' ''~' ./~q .N.~, ~ 1~¢.~., ~u~.ifi, ~T. ,.. ~1 X ............ P Y 2. State existing use and occupancy of premises an d intended use and occupancy of proposed construction. a. Existing use and occupancy .. ~.~!q)Y)..~. · /-/ff'14.~.C~ C~t~t- ~.~ · ' ......... : ............................. b. Int*nded use and occupancy ..... ............... . ........... 3. Nature of work (check which applicable): New'Building ........ Addition ........ Alteration ........ Repair ......... Re;novel ........ ,Demoli~i, on ........ Other Work (Describe) ...................... 4. timated ................................................ ,, o' (to be paid on filing this application)~ ; ,, 5. If ,dwelling, number of dwelling units ~/..°..f..~_. Number of dwelling units on each floor~. If gara e number of cars /,p0~,~' , g ! .......................................................... ~,'. ......~,ed,roo~,, · 6. If business, commercial or mixed occupancy, specify nature ~an)d extent of each type of use.: .... 7. Dimens~.~s_pf~_existi, ng structures, if any: Front ~¢0./~..~/...~..~Rear . .~ .L-~.., .... Depth . Height /.~... ~/.7..~?.. Number of Stories .. f. './~,~ ................................................. Dimensions of same structure with .al. terations.oY .~dditions: F~ont . .~l~?.~. ..... Rear . ~ ...... Depth . ~.4~....~fl ....... Height [.~'A~,' Number of S'0oa-ies . ./. 8. Dimensions ~f entire new construction: Front . .~[./.~ ~ ..... ~ " '! ~.~ ~ ....... ~... Rear..~./, .~. ....... Depth ........... HeiglTl~,0 ~.~,." .... .,., Z~umber.o~ $[ories... ~f. ~- ........... ~ .............. ' .............. 9. Size ofl~: Front ................ Rear . .~. ............ Depth .../...e[.L.C¢...e~.~-$~eo 10. Date of Purchase .... /.fg.~. ..................... Name of Farrner Owner ...~..a...C.e..~..~.e~tV'~,s.qO.. 11. Zone ar use district in which premises are situated .~fO.W..n~/.30~h. ~.~eT;f;..e-~.'~ .o.~o.e'~... 12. Does proposed construction viola'~e any ~ming law, ardina2nce or regulation? ....~.0. .................... 13. Name of.Ownerof premises . .~..l.~.~C]~6,_. A, ddress-~.?~.~¢~-~t'~.~'...~.. Phone No..7.~.(~..~.~...A.$. Name of Architect ............................. &ddress ...................... Phone No ............ Name of Contractor ............................ Address ...................... Phone No ............ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give s ,m-eet and block number or description according to deed, and show,'stre%t names and indicate whe~er interior or corner lot. STAT~ OF ~ YORK, )S.S. 'COUNTY OF.. 7~ .... '~ ~..."i~) .................................................... being duly sworn, deposes and says that he is the appli- (Name of individual signing application) cant .above named. He is the ............................................................................ (Oontraetor, agent~ ,c~-i~orate officer, ere.) of said owner ar owners, and is duly authorized ~o per~or~n or have per~rmed the. s~id work and to make and file thi~ application; that all statemerrts contained in this application axe true to the best of his knowledge and belief; .and that the work will be performed in the mann er set fort~ in the application filed therewith. Sworn to bef<rre me this (Signture of applicant) SCALE.: GUA~ANTEEO TO THE TITLE GUAI2A~TBE[ COMPANY AND TOTHE NO~TH ~0~ ~AN~ A~D T~U~T COMPANy SUrVeYED AUGUST I. 1~6~ VA~ TUYL ~ ~ ...........